A tale of meaningful use in two cities

Where an optometrist lives can determine how easy—or challenging—it is to comply with "meaningful use" electronic health record (EHR) requirements. For example, access to support and bandwidth may vary based on location.

Dr. Jordan, who chairs the AOA's Federal Relations Committee, foresees problems for doctors in areas without ready access to IT support companies to help prepare their office for compliance. Although he personally has more than one health IT vendor for support, ODs in smaller towns around the state may not.

"Unless you're very computer-based, it's very difficult to do on your own as an office," he observes.

Even in Dr. Jordan's hometown of Gillette, not a small town by Wyoming's standards, staying up to date has its difficulties—especially with respect to cost, upgrades and IT support. For example, his practice's system uses a standard server, which is more expensive to maintain than a cloud-based system.

His office has met meaningful use requirements. However, he notes a challenge: "There's one Internet line to the whole city, and if that goes down, I go down, too."

The federal government has taken steps to ease the burden of compliance in Medicare's EHR Incentive Program. For example, ODs who face barriers can apply for certain exceptions this July to avoid penalties in 2015. The CMS lists a number of circumstances for hardship exceptions. Eligible providers might live in remote areas and lack sufficient access to the Internet. Or they could face vendor certification issues. EHRs need to be certified for the Medicare incentives program.

The urban ODSome ODs in urban areas, where Internet access is plentiful, haven't needed such exceptions.

"I have to say I'm one of the success stories of meaningful use," says Gregory Foley, O.D., who practices in Washington, D.C., and has taken on the task of compliance in his office.

The practice just finished year two in Stage 1 meaningful use. Dr. Foley says meeting requirements wasn't that difficult, but it did require diligent upkeep.

"A lot of the software companies have a reporting system that lists all of the meaningful use requirements," he says. "You can populate those reports as you go along for each of the doctors, to make sure those counts are correct for each of the items that you need."

That's where the upkeep comes into play. Dr. Foley regularly runs reports and informs the other ODs in his practice of what they need to do to meet meaningful use quotas. Without such diligence, "it would have been a disaster," Dr. Foley says.

Gearing up for Stage 2Dr. Foley admits he's more concerned about meeting Stage 2 requirements, which include digital communication with patients.

"Most software companies are still working on a version of software to meet a lot of the requirements for Stage 2," he observes.

As part of Stage 2, ODs must make a portal available to patients so they can access their medical records. Whether they live and work in Gillette or Washington, D.C., "I think that's going to be a huge challenge for ODs across the country," Dr. Jordan says.